Healthcare Provider Details

I. General information

NPI: 1386032357
Provider Name (Legal Business Name): STAYWELL SPINE AND JOINT SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26200 TOWN CENTER DR STE 165
NOVI MI
48375-1219
US

IV. Provider business mailing address

26200 TOWN CENTER DR STE 165
NOVI MI
48375-1219
US

V. Phone/Fax

Practice location:
  • Phone: 248-513-3100
  • Fax: 248-679-3061
Mailing address:
  • Phone: 248-513-3100
  • Fax: 248-679-3061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY OLSON
Title or Position: OWNER
Credential: D.C.
Phone: 248-513-3100